The Medical Tourism Impact on the ... - Cleveland Clinic · Number and Percentage of JCIA Accredited Hospitals Selected GCC Countries Kingdom of Saudi Arabia (2012) State of Kuwait

The Medical Tourism Impact on

the Global Focus on the Patient

Experience

Mussaad Al-Razouki- Kleos, MD, Chief Executive

Officer, Kleos Healthcare Corporation

YORN ID: 510

This document is confidential and is intended solely for

the use and information of the person/company to whom it is addressed.

CONFIDENTIAL

Kleos Healthcare Corporation “Operating Where Health Meets Wealth”

Improving the Patient Experience in the Middle East

by:

Dr. Mussaad Al-Razouki

2

Introduction to Kuwaiti Healthcare System

Patient Experience Today

Part of the Solution

3




Source: Kleos Healthcare, OECD, GSCPD, MoH, Business Insider

April 2011 CAGR

Hospital Beds 8,757 22.9%

Public Beds 7,635 25.9%

Private Beds 1,122 5.7%

Public Clinics 92 12.2%

Doctors 6,825 2.6%

Nurses 16,107 5.5%

Beds/000 2.43 3-5

Beds/000 Citizen 7.57 3-5

Doctors/000 1.89 2-3

Nurses/000 4.46 5-10

Doctors/Bed 0.78 1-2

Nurses/Doctor 2.36 3-4

Ratio Intl. Best Practice

April 2011

Total MoH Budget ~1 Bn KD

Overseas Health

Budget ~0.5 Bn KD*

Kuwait Private

Insurance Mkt Size ~30-45 mn KD

Kuwaiti Citizens 1,156,914

Expatriates 2,450,930

Spend per population 275 - 330 KD

Spend per Kuwait

citizen 750 KD

Typical Insurance

Premium 250 – 300 KD

US per spend per

citizen ~1,500 KD

Healthcare Growth

Public Healthcare

Spending

Overview of the Kuwaiti Healthcare System

Per Capital Healthcare

Spending in Kuwait

The Ministry of Health’s (MoH) Budget has almost doubled in the past five fiscal years

Kuwaiti Ministry of Health Budget (2006-2012)

2008-9 2008-9 2011-12 2010-11 2009-10

150 mn KD will be spent on Overseas

Treatment (i.e. 10%)

2012-13F

Source: Kleos Healthcare Analysis, Dr. Waleed Al Falah (MoH – Quality and Planning Department, Dr. Eissa Al Misri (MoH -Overseas Planning Department)

Six government entities are building hospitals in Kuwait

Planned number of new public hospital beds in Kuwait by entity

2017 2016 2015

180

2014 2013

300

600

2012 2011 2010

Total number of hospital beds per year

+14%

2020 2019 2018 2017

1,122

2016

1,122

2015

1,122

2014

1,122

2013

1,122

2012

1,122 688

2011 2010

Private

New Public Beds

Public Beds

MoI

PIFSS

KOC

MoPW

Insurance company

MoH

Planned Number of Beds for Government Entities

Note: MoPW - Ministry of Public Works, PIFSS - Public Institute for Social Security, MoI - Ministry of Interior, KOC - Kuwait Oil Company Source: Kleos Healthcare Analysis, Ministry of Health, Ministry of Public Works, Public Institute for Social Security, Ministry of Interior, Kuwait Oil Company

At the current rate of development Kuwait will have 2.5X the

number of hospital beds when compared to hotel rooms by 2020 Kuwait Hospital Beds vs. Hotel Rooms

Total number of hospital beds per year

6,066 7,635 7,93314,763

21,704 24,214 25,332 25,144 25,144 25,144 25,144

0

15,000

30,000

CAGR : 14%

2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010

Total number of hotel rooms per year

6,698 7,033 7,385 7,754 8,142 8,549 8,976 9,425 9,896 10,391 10,911

0

10,000

20,000

30,000CAGR: 5%

2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010

Note: CAGR – Compound Annual Growth Rate Source: Kleos Healthcare Analysis, Trimideast (2004),

7

24%

28% 15%

16%

7%

10%

Pediatric

416

The utilization of current government healthcare facilities is sub-optimal

8

80%

65%

50%

7.5 5.5 3.5 1.5

33%

53%

14%

18%

29% 33%

18%

2%

28%

48%

19%

Sabah

(511 beds)

Amiri (418 beds)

Mubarak Al Kabeer (509 beds)

Adan

(715 beds)

Jahra

(752 beds)

Average length of stay (days)

Oc

cu

pa

nc

y R

ate

Internal

General

Surgery

Gyn. &

Obs.

ENT

Others

0%

15 10 5 0

Average Length of stay (days)

Oc

cu

pa

nc

y R

ate

General Hospitals

(Size of bubbles represent the number of beds)

ICU

40%

80%

269

Al-Razi

(Orthopedics)

Maternity Hospital

290 Pulmonology

364

Bin Sena (Specialized Surgery) 191

Cancer

196

Communicable diseases

Selected Specialized Hospitals

(Size of bubbles represent the number of beds)

Source: Kleos Health Analysis, Ministry of Health data

Farwaniya(838 beds)

//

60%

A ‘Quality Gap’ still persists in terms of the provision of healthcare services in Kuwait (and the GCC)

Number and Percentage of JCIA Accredited Hospitals Selected GCC Countries

Kingdom of Saudi Arabia

(2012)

State of Kuwait

(2012)

36

408

JCIA Total

2

JCIA Total

19

(8.8%) (8.3%)

Note: JCIA – Joint Commission International is used as a proxy for healthcare quality measures

Source: Kleos Analysis

*

10




11



Local Care


The Kuwaiti patient is disenfranchised with the current state of the healthcare system, a change is needed

Current State of System: Centralized Recommended End State:

Decentralized and Accountable

Today

• Lack of focus among entities

• Lack of integration

• Overlap of services and lack of oversight on healthcare abroad (separate for each ministry)

Benefits

• Increase patient choice leads to competition and improved performance orientation

• Double quality control through single regulator and insurance system

• Improved internal processes

• Decreased government expenditure on healthcare

Results in

• Low utilization of current resources

• Lack of single country-wide master plan

• Wasteful expenditure of healthcare resources (fiscal, clinical and administrative

Healthcare Abroad

Ministry of Health

(MoH)

Private

Sector

Regulators

Provider

(e.g., Clinics,

Hospitals)

Payor

(e.g., TPA’s,

Insurance)

Other

Public

Sector

e.g.,

KU/

KOC

Military

e.g.,

MoD/

MoInt

Single Regulator

(e.g. Kuwait Health Authority)

MoH

Private

Private Health

Insurance System

*initially funded by the government*

Other

Public

Sector

e.g., KU/

KOC

Military

e.g.,

MoD/

MoInt

Central Intl

Health Office

Paym

en

t

Syste

m

Source: Kleos Healthcare

“The state of our healthcare system is so deplorable,

hospitals are so crowded, we must only have 1 doctor for

every 10 people!”

- Kuwaiti patient

13 Source: Kleos Healthcare

Overall perception of care is low, primary care access is superb, secondary care is acceptable and tertiary care is almost non existent

14

Ministry of Health

Military and Oil

Company

Private

Primary Secondary Tertiary

Access 24/7 in most areas

Free and treatment medication for nationals

Miniscule co-payments for expatriates

Lowest quality perception



Latest equipment

Long waiting times



Latest equipment

Limited procedures and long waiting times

Private health insurance

Free and treatment medication for employees

Used to have highest quality perception

Highest quality perception

Perceived as profit motivated

Focus on beauty and cosmetics

Highest quality perception

Perceived as profit motivated

Focus on beauty and cosmetics







Virtually Non existent


15

Government care is very reactionary

Government Preventative Medicine Tactics are too little too late

16

Public Perception:

Unprofessional | Too late | Static | Soviet era

17



International Care


Ministry of Health

Dr. Ali Al Obaidi

Ministry of Defense

Sheikh Ahmad Khalid Al Hamad Al Sabah

Amiri Diwan

Sheikh Sabah Al Ahmad Al Jaber Al Sabah

Crown Prince Diwan

Sheikh Nawaf Al Ahmad Al Jaber Al Sabah

Prime Minister’s Diwan

Sheikh Jaber Al Mubarak Al Hamad Al Sabah

Kuwait Oil Company

Chairman, Sami Al Rushaid

Send the majority of patients abroad

Six government entities send patients abroad



Four to five distinct departments are involved in sending patients abroad on behalf of the Ministry of Health (MoH)

Foreign Medical

Services Provider

Treatment

Abroad

Department

(MoH)

Adult/Pediatric

Treatment

Abroad

Committee

Overseas Medical

Tourism Office

(e.g. D.C.,

London)

MoH Hospital

(e.g. Amiri, Al

Razzi)

Forms sent to

Hospital

Fill out forms

for Treatment

Abroad

Committee Meets

to Review Case

2

3

5

4

File Opened

7

Main Treatment

Abroad

Committee

Override Denial

Main Committee

Meets to Review

Case

No

Yes

Yes

File Transferred

Appointment

Provided

Location Decided

Location Decided

Approve Case

Specialist

Consultation

1

Case Rejected

6

9

10

4a

5a

No

MoH Underseec. Approval

No

Yes

6a

8

Yes

Source: Kleos Healthcare Analysis, MoH Interviews

Standard Procedure

Decision


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Patient dissatisfaction with healthcare quality resulting in the preference for Kuwaiti patients to seek treatment abroad

23

Percentage of population who prefer medical care in

another country Number of patients sent abroad for treatment (1)

35%

39%

43%

43%

47%

65%

0% 10% 20% 30% 40% 50% 60% 70%

KSA

UAE

Oman

Qatar

Bahrain

Kuwait 5210

2863

520 483

39 35 0

1000

2000

3000

4000

5000

6000

Kuwait UAE Qatar KSA Oman Bahrain

The general pubic perceives there to be lower quality healthcare provided through both the government and private sector in the

GCC and therefore prefer to be treated abroad

It is reported that the UAE currently spends $2 billion (USD) on treatment abroad (compared to $1.8 billion USD that the

government of Kuwait spends). Altogether the GCC is spending approximately $7.2 billion to 12 billion (USD) on treatment abroad

(with roughly 80% of that spend representing the government spending)

(1)= MoH 2006 data

Source: Kleos Health Analysis, Gullup Survey (2011)

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Part of the Solution?

Kuwait Health Assurance Company

26

Arabi group recently won the bid on the Kuwait Health Assurance Company (“KHAC”)

Executive Summary

Implemention and

Management Immediate

Goal

Governance

Establish KHAC Management

Company Establishment and Management of three

hospitals (~750 beds) in Jahra (Amghara),

Farwaniya (Dhajeej) and Ahmadi (South

Sabahiya)

10 primary care health clinics with one in at

least each governorate

One single day surgery center in Hawally

~ 1,000 doctors & 3,000 clinical staff

Target Market: 1.2 to 1.7 million expatriate

population of Kuwait working in private sector

Compulsory Healthcare Assurance services

Total Capital Cost to realize KHAC: 230 mn KD*

– 26% to Arabi Group for 66.7mn KD (163 fils/share)

Arabi Group

Consortium

Kuwait Health

Assurance Company

(KHAC)

Note: 1) Hospitals include both general and specialty hospitals, primary, secondary and specialty care clinics, and all auxiliary and health related facilities, * According to KHAC Auction Document

PMCP: Project Management Project Construction, CRO = Contract Resource Organization

Key

Success

Factors

International Hospital Management Brand

International Hospital Design Company

International Health Insurance Company

Investment Company/Private Equity Company

PMCM Company

CRO Company

Four board seats to Arabi Group Consortium

Three seats shared by the government

1 – JAHRA

2 – FARWANIYA

3 – AHMADI

Potential Catchment

Area

KHAC Hospitals

1 – Jahra

2 – Farwaniya

3 - Ahmadi

Kleos Immediate

Acquisition Targets

1 –Hospital

2 –Clinic

Private Hospitals

1 New Mowasat

2 Omoma

3 Salam

4 Dar Al Shifa

5 Royal Hyatt

6 Hadi

7 Rashed

8 Sief

9 International

10 Safat American

11 London

27

Government Hospitals

1 Sabah

2 Amiri

3 Mubarak

4 Farwaniya

5 Adan

6 Jahra

7 Jaber

8 Ahmadi (KOC)

Overview of Location of Kuwaiti Hospitals

Sources: Kleos Analysis

28




Local: The AbiDoc Cloud Based Network and System

AbiDoc is at its core an online directory, patient scheduling and reminder service that connects doctors to patients

Choose an available

date and time and book an

appointment directly online

and/or through a contact

center

Learn more about a

doctor including

educational background, board

certifications, and professional

memberships

Search for a doctor based on

specialty, location, insurance carrier

and plan, reason for visit, language,

and/or gender

Step 1 –

Accurate search

Step 2 –

Transparent research

Step 3 –

Convenient booking

Patients can more easily find, learn about, and book an appointment with a doctor that fits their needs Doctors can more effectively market themselves to patients and fill out empty appointment slots

STRICTLY CONFIDENTIAL


Available on Android and iOS

GPS based search

Notification reminders 24 and 3 hours before appointment

Booking process duration < 1 minute

On browsers, AbiDoc’s platform is responsive, with the layout adjusting depending on the size of the screen and/or window detected

Whether the

website or the

mobile

applications, the

AbiDoc platform is

under continuous

development


35

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37

38

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AbiDoc is only the beginning…introducing SEHATech

40

http://www.abidoc.com/

http://www.waseel.com/

AbiDoc: is the Middle East region’s first cloud based scheduling

solution that allows patients to book direct appointments with

doctors online through a website and both iOS and Android

Waseel: created a link between 13 major insurance companies, 110

hospitals and over 1390 clinics and medical centers in Saudi Arabia

running around 1.7 mn online transactions per month

Saudi Telecom: STC is the regions largest telecommunications and

IT provider with 150bn SAR of revenue through mobile, fixed line

and enterprise services with customers in 10 countries in Asia and

Africa

SEHATech combines the vision of AbiDoc with the execution strength of Waseel and the reach of Saudi Telecom (STC)

Note: SEHATech stands for Saudi Electronic Health Application Technology Company and also means “Your Health” in Arabic STRICTLY CONFIDENTIAL


http://www.stc.com.sa/








Health Information System (B2B) Hub:

o SEHATtech plans to migrate all hospital/clinic administrative procedures onto its proprietary cloud based system

o These include: EHR, Medical Charting, Billing, Accounting, Inventory Management, Imaging (RIS/PACS), etc.

o Directory and scheduling platform is currently online via www.AbiDoc.com

Predictive Analytics (B2B):

o Healthcare in the MENA region suffers from opacity and lack of information on quality

o SEHATech plans to address that gap and become the number one reference for healthcare quality indicators through its AbiDoc Quality Algorithm that will quantitatively indicate a regions top doctor, clinic, hospital and even insurance plan

Disease Management (B2B):

o As the MENA private insurance market evolves, SEHATech will develop the regions first Disease Management platform whereby patient treatment plans are vetted before the procedure as opposed to a bulk discount

o SEHATech will also offer medical Q&A services online

Doctor eStore (B2B):

o As AbiDoc will already have the largest network of doctors in MENA, an online store can be developed that will allow these doctors to buy their medical supplies

o Orders will be automatically generated by the AbiDoc HIS Inventory Management module with preselected vendors while offering SEHATech doctors a bulk discount

SEHATech: A Cloud-based Hub for “all things Health IT” in MENA

SOURCE: SEHATech Business Plan (Updated December 2013)

We aspire to establish SEHATech as the health IT hub of MENA

SEHATech

Health IT Hub of MENA

Health Information

System

Predictive Analytics

Disease Manage-

ment

Doctor eStore

Electronic Health Records

Digital Imaging Module

Laboratory Module

Clinical Capacity Reports

Patient Experience Reports

Health Industry Statistics

SEHATech is developing partnerships with leading technology companies to improve access and accountability in MENA health

44

45




International Care: MEDtrip.com

Introducing MEDtrip, the world’s first multi-lingual medical tourism portal available in Arabic, English, Spanish and Mandarin

46

www.MEDtrip.com

http://www.MEDtrip.com

47

Thank you

48

Middle East healthcare

leaders have turned to

Kleos for insights, trends

and direction on local

healthcare issues

Kleos has a

demonstrated track

record of identifying

trends and leveraging

key market insights that

drive change in the

current MENA

healthcare affecting the

way that health services

will be delivered in the

future.

With deep knowledge in

both the public and

private sectors, Kleos is

a proven and valued

resource for the region For more info visit www.kleoshealth.com

Documents

The Medical Tourism Impact on the ... - Cleveland Clinic · Number and Percentage of JCIA Accredited Hospitals Selected GCC Countries Kingdom of Saudi Arabia (2012) State of Kuwait